A Tale of Two States: Reconciling Medicaid Work Requirement Enrollment Impacts in Georgia and Arkansas

Medicaid work requirements have reemerged as a major federal policy, yet evidence on their enrollment effects is sparse. We reconcile sharply different outcomes from the only two states that implemented Medicaid work requirements: Arkansas, which reported high compliance, and Georgia, where enrollment has remained extremely low. We distinguish theoretical eligibility from observed enrollment and show that administrative reporting design is a first-order determinant of enrollment under Medicaid work requirements. Using monthly Medicaid enrollment data from Arkansas, we document a strong relationship between manual reporting and noncompliance and show that Georgia’s fully manual system yields enrollment consistent with this mechanism.